Crisis hotlines are one of the oldest suicide prevention resources in the United States, and are now ubiquitous sources of help worldwide. Yet, pervasive concerns exist about the clinical effectiveness of these services and the extent to which high-risk individuals are utilizing these resources. As such, we - from federal agencies to local communities - are relying on a relatively untested method of help for those individuals considered most at risk for suicide death. The current project is focusing on a situation of tremendous policy impact that has arisen: the National Suicide Prevention Lifeline's roll out (starting in winter of 2008) of a training program, using the LivingWorks'Applied Suicide Intervention Skills Training (ASIST), across its network of telephone crisis centers. A critical question to be answered by this resubmission is whether the training program is necessary, by virtue of its increasing the effectiveness of telephone crisis services. In recognition of the application 's policy import, due to the emergent use of hotlines and their expanded use by the Department of Veterans Affairs, as well as the innovativeness of the design, a one-year "NIH High Priority, Short-Term Project Award" (1R56MH082537-01) was granted to develop and implement the procedures that were planned for the first year of the study, including the commencement of data collection. The research protocol, timed to commence with NSPL's ASIST training, has randomized 18 centers to three training sessions (N= 6 centers per training) over a two year period, employing a dynamic wait-listed design for randomized trials (Brown et al., 2006). All 18 centers will receive the intervention, and the timing of the intervention is randomly assigned. Through the dynamic wait-listed design this will be the first controlled study of whether trained telephone crisis counselors adequately assess and refer callers. Assessments of each of the 18 centers commenced in June 2008 and will optimally conclude in December 2009. These assessments will include silent monitoring of calls linked to follow-up telephone interviews with callers (N = 1,920) to the NSPL's 1-800 numbers. An assessment of the transfer/fidelity of the training will be incorporated into the design by the employment of "generation 1" trainer counselors'self-administered questionnaires, ratings of videotapes of the ASIST workshops they give to the "generation 2" counselors in their centers, and through the observation of calls via the silent monitoring. The dynamic wait-listed design will not be able to be completed without the funding of the current R01 application. The training of the 3rd cohort of 6 centers will not occur and data collection will have to end 9 months prematurely. This will clearly preclude our ability to address the aims of the study, needed to inform the future of the national network of telephone crisis services, which currently serves as the "safety net" for many national public health initiatives to prevent suicide and we will lose the rare opportunity for a research study to have such direct relevance to existing and future policy decisions. The roll out of the Applied Suicide Intervention Skills Training (ASIST) across the National Suicide Prevention Lifeline's network of telephone crisis centers and the expanded use of hotlines, particularly among the Department of Veterans Affairs and others, has prompted this application, which will answer whether the training program is necessary, by virtue of its increasing the effectiveness of telephone crisis services. This information is critically needed to inform decisions and plans regarding the optimization of a network of crisis services providing a "safety net" for imminently suicidal individuals. Few such opportunities arise for research studies to have such policy relevance, in other words, to have a direct impact on existing and future policy decisions.